|
8.0 ET TUBE
|
Facility
|
OP
|
$10.30
|
|
| Hospital Charge Code |
4471475
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$8.24 |
| Rate for Payer: Aetna of NY Commercial |
$7.21
|
| Rate for Payer: Aetna of NY Medicare |
$4.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.12
|
| Rate for Payer: Cash Price |
$7.72
|
| Rate for Payer: CDPHP Medicare |
$3.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$8.24
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8.24
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8.24
|
| Rate for Payer: EmblemHealth Medicaid |
$8.24
|
| Rate for Payer: EmblemHealth Medicare |
$3.50
|
| Rate for Payer: EmblemHealth Select Care |
$7.42
|
| Rate for Payer: Fidelis Medicare |
$4.12
|
| Rate for Payer: Galaxy Health Commercial |
$6.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.12
|
| Rate for Payer: Humana Medicare |
$4.12
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$7.21
|
| Rate for Payer: Local 1199SEIU Medicare |
$4.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7.72
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5.80
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4.33
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.54
|
| Rate for Payer: United Healthcare Medicare |
$4.12
|
| Rate for Payer: WellCare Medicare |
$5.67
|
|
|
8.0 ET TUBE
|
Facility
|
IP
|
$10.30
|
|
| Hospital Charge Code |
4471475
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.70 |
| Max. Negotiated Rate |
$6.70 |
| Rate for Payer: Cash Price |
$7.72
|
| Rate for Payer: Galaxy Health Commercial |
$6.70
|
|
|
8.5 ET TUBE
|
Facility
|
OP
|
$107.12
|
|
| Hospital Charge Code |
4478226
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.07 |
| Max. Negotiated Rate |
$85.70 |
| Rate for Payer: Aetna of NY Commercial |
$74.98
|
| Rate for Payer: Aetna of NY Medicare |
$49.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$42.85
|
| Rate for Payer: Cash Price |
$80.34
|
| Rate for Payer: CDPHP Medicare |
$39.63
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$85.70
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$85.70
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$85.70
|
| Rate for Payer: EmblemHealth Medicaid |
$85.70
|
| Rate for Payer: EmblemHealth Medicare |
$36.42
|
| Rate for Payer: EmblemHealth Select Care |
$77.13
|
| Rate for Payer: Fidelis Medicare |
$42.85
|
| Rate for Payer: Galaxy Health Commercial |
$69.63
|
| Rate for Payer: Hamaspik Choice Medicare |
$42.85
|
| Rate for Payer: Humana Medicare |
$42.85
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$74.98
|
| Rate for Payer: Local 1199SEIU Medicare |
$49.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$80.34
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$60.31
|
| Rate for Payer: MVP Health Care of NY Medicare |
$44.99
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$16.07
|
| Rate for Payer: United Healthcare Medicare |
$42.85
|
| Rate for Payer: WellCare Medicare |
$58.92
|
|
|
8.5 ET TUBE
|
Facility
|
IP
|
$107.12
|
|
| Hospital Charge Code |
4478226
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$69.63 |
| Max. Negotiated Rate |
$69.63 |
| Rate for Payer: Cash Price |
$80.34
|
| Rate for Payer: Galaxy Health Commercial |
$69.63
|
|
|
8CMX5M COMPRILAN
|
Facility
|
IP
|
$19.57
|
|
| Hospital Charge Code |
4471080
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.72 |
| Max. Negotiated Rate |
$12.72 |
| Rate for Payer: Cash Price |
$14.68
|
| Rate for Payer: Galaxy Health Commercial |
$12.72
|
|
|
8CMX5M COMPRILAN
|
Facility
|
OP
|
$19.57
|
|
| Hospital Charge Code |
4471080
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$15.66 |
| Rate for Payer: Aetna of NY Commercial |
$13.70
|
| Rate for Payer: Aetna of NY Medicare |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$7.83
|
| Rate for Payer: Cash Price |
$14.68
|
| Rate for Payer: CDPHP Medicare |
$7.24
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$15.66
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$15.66
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$15.66
|
| Rate for Payer: EmblemHealth Medicaid |
$15.66
|
| Rate for Payer: EmblemHealth Medicare |
$6.65
|
| Rate for Payer: EmblemHealth Select Care |
$14.09
|
| Rate for Payer: Fidelis Medicare |
$7.83
|
| Rate for Payer: Galaxy Health Commercial |
$12.72
|
| Rate for Payer: Hamaspik Choice Medicare |
$7.83
|
| Rate for Payer: Humana Medicare |
$7.83
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$13.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$9.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$14.68
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$11.02
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.22
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.94
|
| Rate for Payer: United Healthcare Medicare |
$7.83
|
| Rate for Payer: WellCare Medicare |
$10.76
|
|
|
8FR 3CC FOLEY
|
Facility
|
OP
|
$24.72
|
|
| Hospital Charge Code |
4478207
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.71 |
| Max. Negotiated Rate |
$19.78 |
| Rate for Payer: Aetna of NY Commercial |
$17.30
|
| Rate for Payer: Aetna of NY Medicare |
$11.37
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$9.89
|
| Rate for Payer: Cash Price |
$18.54
|
| Rate for Payer: CDPHP Medicare |
$9.15
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$19.78
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$19.78
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$19.78
|
| Rate for Payer: EmblemHealth Medicaid |
$19.78
|
| Rate for Payer: EmblemHealth Medicare |
$8.40
|
| Rate for Payer: EmblemHealth Select Care |
$17.80
|
| Rate for Payer: Fidelis Medicare |
$9.89
|
| Rate for Payer: Galaxy Health Commercial |
$16.07
|
| Rate for Payer: Hamaspik Choice Medicare |
$9.89
|
| Rate for Payer: Humana Medicare |
$9.89
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$17.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$11.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$18.54
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$13.92
|
| Rate for Payer: MVP Health Care of NY Medicare |
$10.38
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.71
|
| Rate for Payer: United Healthcare Medicare |
$9.89
|
| Rate for Payer: WellCare Medicare |
$13.60
|
|
|
8FR 3CC FOLEY
|
Facility
|
IP
|
$24.72
|
|
| Hospital Charge Code |
4478207
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.07 |
| Max. Negotiated Rate |
$16.07 |
| Rate for Payer: Cash Price |
$18.54
|
| Rate for Payer: Galaxy Health Commercial |
$16.07
|
|
|
8FR CATHETER KIT 10820
|
Facility
|
OP
|
$13.39
|
|
| Hospital Charge Code |
4479287
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$10.71 |
| Rate for Payer: Aetna of NY Commercial |
$9.37
|
| Rate for Payer: Aetna of NY Medicare |
$6.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.36
|
| Rate for Payer: Cash Price |
$10.04
|
| Rate for Payer: CDPHP Medicare |
$4.95
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$10.71
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$10.71
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$10.71
|
| Rate for Payer: EmblemHealth Medicaid |
$10.71
|
| Rate for Payer: EmblemHealth Medicare |
$4.55
|
| Rate for Payer: EmblemHealth Select Care |
$9.64
|
| Rate for Payer: Fidelis Medicare |
$5.36
|
| Rate for Payer: Galaxy Health Commercial |
$8.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.36
|
| Rate for Payer: Humana Medicare |
$5.36
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$9.37
|
| Rate for Payer: Local 1199SEIU Medicare |
$6.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10.04
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7.54
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.62
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.01
|
| Rate for Payer: United Healthcare Medicare |
$5.36
|
| Rate for Payer: WellCare Medicare |
$7.36
|
|
|
8FR CATHETER KIT 10820
|
Facility
|
IP
|
$13.39
|
|
| Hospital Charge Code |
4479287
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.70 |
| Max. Negotiated Rate |
$8.70 |
| Rate for Payer: Cash Price |
$10.04
|
| Rate for Payer: Galaxy Health Commercial |
$8.70
|
|
|
.9% SODCH 1000ML IRRIGATION BAG
|
Facility
|
OP
|
$4.12
|
|
| Hospital Charge Code |
4479241
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$3.30 |
| Rate for Payer: Aetna of NY Commercial |
$2.88
|
| Rate for Payer: Aetna of NY Medicare |
$1.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1.65
|
| Rate for Payer: Cash Price |
$3.09
|
| Rate for Payer: CDPHP Medicare |
$1.52
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3.30
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3.30
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3.30
|
| Rate for Payer: EmblemHealth Medicaid |
$3.30
|
| Rate for Payer: EmblemHealth Medicare |
$1.40
|
| Rate for Payer: EmblemHealth Select Care |
$2.97
|
| Rate for Payer: Fidelis Medicare |
$1.65
|
| Rate for Payer: Galaxy Health Commercial |
$2.68
|
| Rate for Payer: Hamaspik Choice Medicare |
$1.65
|
| Rate for Payer: Humana Medicare |
$1.65
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$2.88
|
| Rate for Payer: Local 1199SEIU Medicare |
$1.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3.09
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2.32
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1.73
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.62
|
| Rate for Payer: United Healthcare Medicare |
$1.65
|
| Rate for Payer: WellCare Medicare |
$2.27
|
|
|
.9% SODCH 1000ML IRRIGATION BAG
|
Facility
|
IP
|
$4.12
|
|
| Hospital Charge Code |
4479241
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$2.68 |
| Rate for Payer: Cash Price |
$3.09
|
| Rate for Payer: Galaxy Health Commercial |
$2.68
|
|
|
.9 % SOD CHLOR. 3000ML IRRIGA
|
Facility
|
OP
|
$28.84
|
|
| Hospital Charge Code |
4471596
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.33 |
| Max. Negotiated Rate |
$23.07 |
| Rate for Payer: Aetna of NY Commercial |
$20.19
|
| Rate for Payer: Aetna of NY Medicare |
$13.27
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$11.54
|
| Rate for Payer: Cash Price |
$21.63
|
| Rate for Payer: CDPHP Medicare |
$10.67
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$23.07
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$23.07
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$23.07
|
| Rate for Payer: EmblemHealth Medicaid |
$23.07
|
| Rate for Payer: EmblemHealth Medicare |
$9.81
|
| Rate for Payer: EmblemHealth Select Care |
$20.76
|
| Rate for Payer: Fidelis Medicare |
$11.54
|
| Rate for Payer: Galaxy Health Commercial |
$18.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$11.54
|
| Rate for Payer: Humana Medicare |
$11.54
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$20.19
|
| Rate for Payer: Local 1199SEIU Medicare |
$13.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$21.63
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$16.24
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.11
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.33
|
| Rate for Payer: United Healthcare Medicare |
$11.54
|
| Rate for Payer: WellCare Medicare |
$15.86
|
|
|
.9 % SOD CHLOR. 3000ML IRRIGA
|
Facility
|
IP
|
$28.84
|
|
| Hospital Charge Code |
4471596
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.75 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Cash Price |
$21.63
|
| Rate for Payer: Galaxy Health Commercial |
$18.75
|
|
|
ABDOMINAL PARACENTESIS (DIAGNOSTIC OR TH
|
Facility
|
IP
|
$2,813.00
|
|
|
Service Code
|
HCPCS 49082
|
| Hospital Charge Code |
4609609
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,828.45 |
| Max. Negotiated Rate |
$1,828.45 |
| Rate for Payer: Cash Price |
$2,109.75
|
| Rate for Payer: Galaxy Health Commercial |
$1,828.45
|
|
|
ABDOMINAL PARACENTESIS (DIAGNOSTIC OR TH
|
Facility
|
OP
|
$2,813.00
|
|
|
Service Code
|
HCPCS 49082
|
| Hospital Charge Code |
4609609
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$421.95 |
| Max. Negotiated Rate |
$2,250.40 |
| Rate for Payer: Aetna of NY Commercial |
$1,000.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,293.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,125.20
|
| Rate for Payer: Cash Price |
$2,109.75
|
| Rate for Payer: Cash Price |
$2,109.75
|
| Rate for Payer: Cash Price |
$2,109.75
|
| Rate for Payer: CDPHP Medicare |
$1,040.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,206.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,250.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,250.40
|
| Rate for Payer: EmblemHealth Medicaid |
$2,250.40
|
| Rate for Payer: EmblemHealth Medicare |
$956.42
|
| Rate for Payer: EmblemHealth Select Care |
$1,085.00
|
| Rate for Payer: Fidelis Medicare |
$1,125.20
|
| Rate for Payer: Galaxy Health Commercial |
$1,828.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,125.20
|
| Rate for Payer: Humana Medicare |
$1,125.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,000.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,293.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,234.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$925.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,181.46
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,009.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$421.95
|
| Rate for Payer: United Healthcare Commercial |
$1,009.00
|
| Rate for Payer: United Healthcare Medicare |
$1,125.20
|
| Rate for Payer: WellCare Medicare |
$1,547.15
|
|
|
ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
HCPCS 49083 26
|
| Hospital Charge Code |
5201079
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$214.50 |
| Max. Negotiated Rate |
$214.50 |
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Galaxy Health Commercial |
$214.50
|
|
|
ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
HCPCS 49083 26
|
| Hospital Charge Code |
5201079
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$49.50 |
| Max. Negotiated Rate |
$264.00 |
| Rate for Payer: Aetna of NY Commercial |
$231.00
|
| Rate for Payer: Aetna of NY Medicare |
$151.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$132.00
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: CDPHP Medicare |
$122.10
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$264.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$264.00
|
| Rate for Payer: EmblemHealth Medicaid |
$264.00
|
| Rate for Payer: EmblemHealth Medicare |
$112.20
|
| Rate for Payer: Fidelis Medicare |
$132.00
|
| Rate for Payer: Galaxy Health Commercial |
$214.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$132.00
|
| Rate for Payer: Humana Medicare |
$132.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$231.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$151.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$247.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$185.79
|
| Rate for Payer: MVP Health Care of NY Medicare |
$138.60
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$49.50
|
| Rate for Payer: United Healthcare Medicare |
$132.00
|
| Rate for Payer: WellCare Medicare |
$181.50
|
|
|
ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE
|
Facility
|
OP
|
$2,813.00
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
4201079
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$421.95 |
| Max. Negotiated Rate |
$2,250.40 |
| Rate for Payer: Aetna of NY Commercial |
$1,969.10
|
| Rate for Payer: Aetna of NY Medicare |
$1,293.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,125.20
|
| Rate for Payer: Cash Price |
$2,109.75
|
| Rate for Payer: Cash Price |
$2,109.75
|
| Rate for Payer: CDPHP Medicare |
$1,040.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,969.10
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,250.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,250.40
|
| Rate for Payer: EmblemHealth Medicaid |
$2,250.40
|
| Rate for Payer: EmblemHealth Medicare |
$956.42
|
| Rate for Payer: EmblemHealth Select Care |
$1,828.45
|
| Rate for Payer: Fidelis Medicare |
$1,125.20
|
| Rate for Payer: Galaxy Health Commercial |
$1,828.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,125.20
|
| Rate for Payer: Humana Medicare |
$1,125.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,969.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,293.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,109.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,583.72
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,181.46
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$489.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$421.95
|
| Rate for Payer: United Healthcare Commercial |
$489.00
|
| Rate for Payer: United Healthcare Medicare |
$1,125.20
|
| Rate for Payer: WellCare Medicare |
$1,547.15
|
|
|
ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE
|
Facility
|
IP
|
$2,813.00
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
4201079
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,828.45 |
| Max. Negotiated Rate |
$1,828.45 |
| Rate for Payer: Cash Price |
$2,109.75
|
| Rate for Payer: Galaxy Health Commercial |
$1,828.45
|
|
|
AB; HIV-1 & HIV-2 SGL ASSAY
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
HCPCS 86703
|
| Hospital Charge Code |
4301302
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.15 |
| Max. Negotiated Rate |
$33.52 |
| Rate for Payer: Aetna of NY Commercial |
$26.65
|
| Rate for Payer: Aetna of NY Medicare |
$18.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$16.40
|
| Rate for Payer: Cash Price |
$30.75
|
| Rate for Payer: Cash Price |
$30.75
|
| Rate for Payer: CDPHP Medicare |
$15.17
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$24.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$18.71
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$15.59
|
| Rate for Payer: EmblemHealth Medicaid |
$15.59
|
| Rate for Payer: EmblemHealth Medicare |
$13.94
|
| Rate for Payer: EmblemHealth Select Care |
$24.60
|
| Rate for Payer: Fidelis Medicare |
$16.40
|
| Rate for Payer: Galaxy Health Commercial |
$26.65
|
| Rate for Payer: Galaxy Health Workers Comp |
$15.28
|
| Rate for Payer: Hamaspik Choice Medicaid |
$15.59
|
| Rate for Payer: Hamaspik Choice Medicare |
$16.40
|
| Rate for Payer: Humana Medicare |
$16.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$26.65
|
| Rate for Payer: Local 1199SEIU Medicare |
$18.86
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$16.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$30.75
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$33.52
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$33.52
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$23.08
|
| Rate for Payer: MVP Health Care of NY Medicare |
$17.22
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$30.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.15
|
| Rate for Payer: United Healthcare Commercial |
$30.75
|
| Rate for Payer: United Healthcare Medicare |
$16.40
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$16.37
|
| Rate for Payer: WellCare Medicare |
$22.55
|
|
|
AB; HIV-1 & HIV-2 SGL ASSAY
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
HCPCS 86703
|
| Hospital Charge Code |
4301302
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.65 |
| Max. Negotiated Rate |
$26.65 |
| Rate for Payer: Cash Price |
$30.75
|
| Rate for Payer: Galaxy Health Commercial |
$26.65
|
|
|
AB; HSV 1
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS 86695
|
| Hospital Charge Code |
4301304
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Galaxy Health Commercial |
$26.00
|
|
|
AB; HSV 1
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS 86695
|
| Hospital Charge Code |
4301304
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$32.00 |
| Rate for Payer: Aetna of NY Commercial |
$26.00
|
| Rate for Payer: Aetna of NY Medicare |
$18.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$16.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: CDPHP Medicare |
$14.80
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$24.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$32.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$32.00
|
| Rate for Payer: EmblemHealth Medicaid |
$32.00
|
| Rate for Payer: EmblemHealth Medicare |
$13.60
|
| Rate for Payer: EmblemHealth Select Care |
$24.00
|
| Rate for Payer: Fidelis Medicare |
$16.00
|
| Rate for Payer: Galaxy Health Commercial |
$26.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$16.00
|
| Rate for Payer: Humana Medicare |
$16.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$26.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$18.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$30.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$22.52
|
| Rate for Payer: MVP Health Care of NY Medicare |
$16.80
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$30.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.00
|
| Rate for Payer: United Healthcare Commercial |
$30.00
|
| Rate for Payer: United Healthcare Medicare |
$16.00
|
| Rate for Payer: WellCare Medicare |
$22.00
|
|
|
ABO AND RH TYPE
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
HCPCS 86900
|
| Hospital Charge Code |
4300011
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$265.20 |
| Max. Negotiated Rate |
$265.20 |
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Galaxy Health Commercial |
$265.20
|
|
